Ferric sulfate pulpotomy in primary molars: A retrospective study

Author(s): Nikki Smith DDS MS, Sue Seale DDS MSD, Martha Nunn DDS PhD
Journal: Pediatric Dentistry
Volume (number): 22:3
Month, Year: March 2000
Major topic: Legitimacy of ferric sulfate as a pulpotomy medicament
Type of Article: Retrospective study

Overview of method of research: A solo private practitioner performed a retrospective chart review of ferric sulfate pulpotomies performed between 1994 and 1998. Radiographs and clinical chart notes were used to determine radiographic and clinical success in 242 primary molars. These primary molars had a vital carious exposure, no evidence of pulpal degeneration, were restorable with an SSC and for patients who returned for at least one follow up. Radiographic success was based on observation of: unremarkable, external root resorption, internal root resorption, interradicular bone destruction, calcific metamorphosis, uneven root resorption compared to contralateral tooth, early eruption and root perforation. Clinical success was determined y presence of pain, tenderness to percussion, swelling, fistulation or pathologic tooth mobility.

Findings: No significant difference between 1st or second molars and no difference between maxillary and mandibular success. No differences between age groups. Overall clinical success rate was 99% with only 5 teeth extracted due to clinical symptoms. Four additional teeth were extracted due to pathologic radiographic findings. Radiographic success was 80% at 4-12 months and 74% >36 months. There were no hypoplastic or hypocalcified areas noted on any succedaneous teeth. The two most common reasons for radiographic failure were internal resorption and calcific metamorphosis. These success rates are similar to previous studies for formocresol but actually lower than other studies for ferric sulfate (mainly radiographic). The incidence of internal resorption in FS pulpotomies may be due to the use of ZOE< previously implicated in causing root resorption. When using formocresol, the mummified tissue acts as a barrier to the effects of ZOE, while there is no barrier when using FS. The authors rethought internal resorption as a ‘failure’ and noted that if the presence of only internal resorption (and no other pathology) was considered a success, the radiographic success rates would become 92% and 84% for their age groups.

Key points/Summary : Ferric sulfate is just plain super.

Assessment of article: Great article and very informative. The only way I could see to further strengthen it is to add a little histological support.

Brian Schmid DMD